Examining the roots of federal policy to address racial disparities in health care

Reviews

"Deluxe Jim Crow will become the authoritative book on health policy and race in the twentieth century. Thomas's breadth of research is astounding. Historians, health policy analysts, politicians, and consumers will have much to learn here."
—Susan M. Reverby, author of Examining Tuskegee: The Infamous Syphilis Study and Its Legacy

"It is now conventional wisdom that the premises and policies of the New Deal were irretrievably racial; legislative concessions and local administration sustained 'Jim Crow' in the shadow of an emerging welfare state. Thomas’s careful study of health policy in the South complicates this picture. By any measure, federal health policy made things substantially better—for the region, for its African American citizens, and for its African American medical professionals. Deluxe Jim Crow is a strong book which should find a wide audience among historians of the South and health scholars."
—Colin Gordon, author of Dead on Arrival: The Politics of Health Care in Twentieth-Century America

"The book was meticulously researched and is well written. It provides a comprehensive account of an aspect of US history rarely addressed in other general health policy books."—Choice

"This richly detailed and beautifully written book traces U.S. health policy from New Deal attempts at introducing racial justice into criteria for federal funding for social projects, through the Truman administrations desegregation of the Armed Services (including the Veterans' Administration hospitals), and into the McCarthy-era backlash."
—Norma Smith, Oral History Review

"Karen Kruse Thomas traces in detail—minute, eye-watering detail with charts, tables and graphs—the history of this aspect of segregation. . . .surely the definitive [book] on this aspect of segregation. . . .This is outstanding scholarship."
—Charles Wheeler, News & Record

"Drawing on meticulous, comprehensive research in published sources, archival materials, and oral interviews, Thomas looks at the debates over and implementation of state and federal health programs in the South, with particular attention given to North Carolina. The result is a book that illuminates the key influence of region and race on health politices in the first half of the twentieth century. It also sheds much-needed light on the neglected topic of medical care in relation to civil rights struggles in the critical pre-Brown v. Board of Education period."
—Lynn Marie Pohl, Bulletin of the History of Medicine

"Kruse aims to bring the realm of health care back into a conversation about racial change that has focused primarily on the arena of education. . . . Kruse has written what will likely become the definitive survey of the state of health care in the South in the New Deal and World War Two era for a long time to come."
—Renee Romano, Social History of Medicine

"Deluxe Jim Crow should appeal to those with an interest in the history of US politics, health policy, medicine, race, and the South."
—Elena Conis, Historian

"Karen Kruse Thomas deftly blends the histories of civil rights and the politics of the New Deal era with the history of medicine and health care in the United States. The result is a masterly treatment of an even stranger element in the career of Jim Crow."
—Andrew M. Manis, Journal of Southern History

Plagued by geographic isolation, poverty, and acute shortages of health professionals and hospital beds, the South was dubbed by Surgeon General Thomas Parran “the nation’s number one health problem.” The improvement of southern, rural, and black health would become a top priority of the U.S. Public Health Service during the Roosevelt and Truman administrations.

Karen Kruse Thomas details how NAACP lawsuits pushed southern states to equalize public services and facilities for blacks just as wartime shortages of health personnel and high rates of draft rejections generated broad support for health reform. Southern Democrats leveraged their power in Congress and used the war effort to call for federal aid to uplift the South. The language of regional uplift, Thomas contends, allowed southern liberals to aid blacks while remaining silent on race. Reformers embraced, at least initially, the notion of “deluxe Jim Crow”—support for health care that maintained segregation. Thomas argues that this strategy was, in certain respects, a success, building much-needed hospitals and training more black doctors.

By the 1950s, deluxe Jim Crow policy had helped to weaken the legal basis for segregation. Thomas traces this transformation at the national level and in North Carolina, where “deluxe Jim Crow reached its fullest potential.” This dual focus allows her to examine the shifting alliances—between blacks and liberal whites, southerners and northerners, activists and doctors—that drove policy. Deluxe Jim Crow provides insight into a variety of historical debates, including the racial dimensions of state building, the nature of white southern liberalism, and the role of black professionals during the long civil rights movement.